Healthcare Provider Details

I. General information

NPI: 1003354713
Provider Name (Legal Business Name): LAUREN MARIE MCMINN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARIE SIMMONS

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SPRING HILL AVE
MOBILE AL
36607-2301
US

IV. Provider business mailing address

1855 SPRING HILL AVE
MOBILE AL
36607-2301
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-3544
  • Fax: 251-476-7456
Mailing address:
  • Phone: 251-471-3544
  • Fax: 251-476-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137067
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: